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NORTH SHORE HEALTHCARE LLC HEALTH CARE PLAN 401k Plan overview

Plan NameNORTH SHORE HEALTHCARE LLC HEALTH CARE PLAN
Plan identification number 501

NORTH SHORE HEALTHCARE LLC HEALTH CARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental

401k Sponsoring company profile

NORTH SHORE HEALTHCARE LLC has sponsored the creation of one or more 401k plans.

Company Name:NORTH SHORE HEALTHCARE LLC
Employer identification number (EIN):475124382
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTH SHORE HEALTHCARE LLC HEALTH CARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-12-01
5012021-12-01
5012020-12-01
5012019-12-01
5012018-12-01
5012017-12-01
5012016-12-01DEANNA DELAPASQUA

Plan Statistics for NORTH SHORE HEALTHCARE LLC HEALTH CARE PLAN

401k plan membership statisitcs for NORTH SHORE HEALTHCARE LLC HEALTH CARE PLAN

Measure Date Value
2021: NORTH SHORE HEALTHCARE LLC HEALTH CARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-12-011,117
Total number of active participants reported on line 7a of the Form 55002021-12-01945
Number of retired or separated participants receiving benefits2021-12-016
Number of other retired or separated participants entitled to future benefits2021-12-010
Total of all active and inactive participants2021-12-01951
2020: NORTH SHORE HEALTHCARE LLC HEALTH CARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-12-011,117
Total number of active participants reported on line 7a of the Form 55002020-12-01945
Number of retired or separated participants receiving benefits2020-12-016
Number of other retired or separated participants entitled to future benefits2020-12-010
Total of all active and inactive participants2020-12-01951
2019: NORTH SHORE HEALTHCARE LLC HEALTH CARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-12-01906
Total number of active participants reported on line 7a of the Form 55002019-12-011,115
Number of retired or separated participants receiving benefits2019-12-012
Number of other retired or separated participants entitled to future benefits2019-12-010
Total of all active and inactive participants2019-12-011,117
2018: NORTH SHORE HEALTHCARE LLC HEALTH CARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-12-011,161
Total number of active participants reported on line 7a of the Form 55002018-12-01891
Number of retired or separated participants receiving benefits2018-12-0115
Number of other retired or separated participants entitled to future benefits2018-12-010
Total of all active and inactive participants2018-12-01906
2017: NORTH SHORE HEALTHCARE LLC HEALTH CARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-12-011,796
Total number of active participants reported on line 7a of the Form 55002017-12-011,145
Number of retired or separated participants receiving benefits2017-12-0116
Number of other retired or separated participants entitled to future benefits2017-12-010
Total of all active and inactive participants2017-12-011,161
2016: NORTH SHORE HEALTHCARE LLC HEALTH CARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-12-01387
Total number of active participants reported on line 7a of the Form 55002016-12-011,793
Number of retired or separated participants receiving benefits2016-12-013
Number of other retired or separated participants entitled to future benefits2016-12-010
Total of all active and inactive participants2016-12-011,796

Form 5500 Responses for NORTH SHORE HEALTHCARE LLC HEALTH CARE PLAN

2021: NORTH SHORE HEALTHCARE LLC HEALTH CARE PLAN 2021 form 5500 responses
2021-12-01Type of plan entitySingle employer plan
2021-12-01Submission has been amendedNo
2021-12-01This submission is the final filingNo
2021-12-01This return/report is a short plan year return/report (less than 12 months)No
2021-12-01Plan is a collectively bargained planNo
2021-12-01Plan funding arrangement – InsuranceYes
2021-12-01Plan funding arrangement – General assets of the sponsorYes
2021-12-01Plan benefit arrangement – InsuranceYes
2021-12-01Plan benefit arrangement – General assets of the sponsorYes
2020: NORTH SHORE HEALTHCARE LLC HEALTH CARE PLAN 2020 form 5500 responses
2020-12-01Type of plan entitySingle employer plan
2020-12-01Submission has been amendedNo
2020-12-01This submission is the final filingNo
2020-12-01This return/report is a short plan year return/report (less than 12 months)No
2020-12-01Plan is a collectively bargained planNo
2020-12-01Plan funding arrangement – InsuranceYes
2020-12-01Plan funding arrangement – General assets of the sponsorYes
2020-12-01Plan benefit arrangement – InsuranceYes
2020-12-01Plan benefit arrangement – General assets of the sponsorYes
2019: NORTH SHORE HEALTHCARE LLC HEALTH CARE PLAN 2019 form 5500 responses
2019-12-01Type of plan entitySingle employer plan
2019-12-01Submission has been amendedNo
2019-12-01This submission is the final filingNo
2019-12-01This return/report is a short plan year return/report (less than 12 months)No
2019-12-01Plan is a collectively bargained planNo
2019-12-01Plan funding arrangement – InsuranceYes
2019-12-01Plan funding arrangement – General assets of the sponsorYes
2019-12-01Plan benefit arrangement – InsuranceYes
2019-12-01Plan benefit arrangement – General assets of the sponsorYes
2018: NORTH SHORE HEALTHCARE LLC HEALTH CARE PLAN 2018 form 5500 responses
2018-12-01Type of plan entitySingle employer plan
2018-12-01Submission has been amendedNo
2018-12-01This submission is the final filingNo
2018-12-01This return/report is a short plan year return/report (less than 12 months)No
2018-12-01Plan is a collectively bargained planNo
2018-12-01Plan funding arrangement – InsuranceYes
2018-12-01Plan funding arrangement – General assets of the sponsorYes
2018-12-01Plan benefit arrangement – InsuranceYes
2018-12-01Plan benefit arrangement – General assets of the sponsorYes
2017: NORTH SHORE HEALTHCARE LLC HEALTH CARE PLAN 2017 form 5500 responses
2017-12-01Type of plan entitySingle employer plan
2017-12-01Submission has been amendedNo
2017-12-01This submission is the final filingNo
2017-12-01This return/report is a short plan year return/report (less than 12 months)No
2017-12-01Plan is a collectively bargained planNo
2017-12-01Plan funding arrangement – InsuranceYes
2017-12-01Plan funding arrangement – General assets of the sponsorYes
2017-12-01Plan benefit arrangement – InsuranceYes
2017-12-01Plan benefit arrangement – General assets of the sponsorYes
2016: NORTH SHORE HEALTHCARE LLC HEALTH CARE PLAN 2016 form 5500 responses
2016-12-01Type of plan entitySingle employer plan
2016-12-01First time form 5500 has been submittedYes
2016-12-01Submission has been amendedNo
2016-12-01This submission is the final filingNo
2016-12-01This return/report is a short plan year return/report (less than 12 months)No
2016-12-01Plan is a collectively bargained planNo
2016-12-01Plan funding arrangement – General assets of the sponsorYes
2016-12-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

ACCURISK SOLUTIONS LLC (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract numberARS103701
Policy instance 1
Insurance contract or identification numberARS103701
Number of Individuals Covered957
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $680,488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ACCURISK SOLUTIONS LLC (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract numberARS1037 01
Policy instance 1
Insurance contract or identification numberARS1037 01
Number of Individuals Covered914
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $705,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ACCURISK SOLUTIONS LLC (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract numberARS103701
Policy instance 1
Insurance contract or identification numberARS103701
Number of Individuals Covered957
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $680,488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GREENWICH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22322 )
Policy contract numberARS103701
Policy instance 1
Insurance contract or identification numberARS103701
Number of Individuals Covered1051
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $718,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberNIS1250 02
Policy instance 1
Insurance contract or identification numberNIS1250 02
Number of Individuals Covered882
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $849,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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